Periprosthetic Joint Infections Impactful Statements

The following impactful statements are based on the Diagnosis and Prevention of Periprosthetic Joint Infections Clinical Practice Guideline.

1. Obtain blood serums and synovial fluid as “first-line” diagnostic tools for a suspected periprosthetic joint infection.

2. Do not initiate antimicrobials until adequate synovial fluid cultures obtained when trying to make the diagnosis of a periprosthetic joint infection.

3. Give prophylactic preoperative antibiotics prior to revision surgery when a periprosthetic joint infection is not suspected or has already been diagnosed with appropriate cultures.

The following recommendation is the basis of the statements above.

1. Strong evidence supports the use of the following to aid in the preoperative diagnosis of prosthetic joint infection (PJI):

  • Serum erythrocyte sedimentation rate (ESR)
  • Serum C-reactive protein (CRP)
  • Serum Interleukin-6

Moderate strength evidence supports the use of the following to aid in the diagnosis of prosthetic joint infection (PJI):

  • Synovial fluid leukocyte count and neutrophil percentage  
  • Synovial fluid aerobic and anaerobic bacterial cultures
  • Synovial fluid leukocyte esterase  
  • Synovial fluid alpha-defensin (α-defensin)  
  • Synovial fluid C-reactive protein (CRP)
  • Synovial fluid nucleic acid amplification testing [e.g., polymerase chain reaction (PCR)] for bacteria

2. Moderate evidence supports avoiding administration of antimicrobials in patients suspected of having a periprosthetic joint infection until cultures have been obtained and a diagnosis has been established.

3. Strong evidence supports that preoperative prophylactic antibiotics be give prior to revision surgery in patients at low preoperative suspicion for periprosthetic infection and those with an established diagnosis of periprosthetic joint infection of know pathogen who are undergoing reoperation.